Matebello Makhanya left her village of Ramabanta early in the morning and travelled 60km to Maseru, Lesotho's capital, in the hope of seeing a dentist at Queen Elizabeth II Hospital – the largest in the country – only to be told that it was about to be closed and dental services were no longer provided there.

"I am very disappointed," she said from a queue outside a small private clinic in the city centre, explaining that initially she had been referred by her local clinic to a hospital about 20km away. "Upon arriving at that hospital, I was told that there is no dental anaesthesia and that the dentist is on leave."

Makhanya's story is echoed by many patients who have resorted to private clinics and pharmacies after struggling to be seen at both government health facilities and those run by the Christian Health Association of Lesotho (Chal), an organisation made up of six different churches that provides 40% of healthcare in the country.

Thabo was forced to go to a private doctor after failing to get drugs or a medical examination at either government or Chal health centres in Maseru. "I went to the government clinic because I was going to pay only 15 maloti ($2.14) but now I have to cough up 120 ($17.14)," he said.

Health centres under strain

In 2007, the government of Lesotho and Chal, which runs 75 health centres and eight hospitals – many of them in rural areas where government health workers are reluctant to work – signed a memorandum of understanding with the aim of making health services more accessible to ordinary Basotho who could not afford even the nominal fees that state and Chal-run health facilities charged. Patients would now get free medical services and drugs at health centres, and subsidised medical care and drugs at hospitals.

However, the resulting influx of patients put a huge strain on health centres and their supply of drugs, and many over-burdened government and Chal health centres have taken to referring patients to private clinics and pharmacies.

The head of pharmacy at the ministry of health and social welfare, Masoko Nt'sekhe, described the situation as "very unfortunate", particularly in the context of a country where about 60% of the population live below the poverty line. However, she insisted that she had received no official reports of drug shortages in hospitals. She added that late ordering of drugs and poor budgeting were more often to blame for shortages than a lack of funds, and that running out of stock was more likely to occur in Chal-run health facilities where the government had no direct control.

Nevertheless, an official at Chal's headquarters in Maseru, who declined to be named, said government hospitals were experiencing drug shortages and that most of the funding her organisation received from the government was spent on salaries and operating costs, leaving little to buy drugs and other medical supplies. Chal relies on the government to make up 80% of its annual budget, with the remaining 20% coming from its six member churches, but according to the official, requests for payment were sometimes ignored.

Nt'sekhe said Lesotho's financial crisis – the result of the global economic slowdown and a sharp decline in crucial revenue from the Southern African Customs Union (Sacu) – had not affected public health services in any way. In fact, while other government ministries have faced budget cuts, the ministry of health and social welfare received a small increase in the 2011-12 financial year and new posts have been created to employ more nurses and pharmacists.

Closure sparks protests

The closure of Queen Elizabeth II Hospital in October is likely to further stretch services at the country's remaining hospitals, although Mateboho Mosebekoa, a public relations officer with the ministry of health and social welfare, denied rumours that patients would be sent home to be cared for by their relatives. She said those needing in-patient care would either be transferred to T'sepong Hospital, a new referral facility outside Maseru's city centre, or to other district hospitals. "Only fully recovered patients will be discharged," she said.

However, unlike the new referral hospital, Queen Elizabeth II served many outpatients and its closure has sparked protests among city residents who worry it will contribute to the gap in affordable health services.

Poor Basotho in rural areas have been the hardest hit by the decline in affordable health services. Mpho Makhobalo, 22, said the local Chal clinic in her village of Nazareth, 43km from Maseru, had become little more than a place for patients living with HIV to collect their antiretroviral drugs. "It no longer qualifies as a clinic," she said. "The nurses who work there only tell those patients who are their friends when drugs are available and when other people go there they are told that the drugs are finished."

A private clinic and pharmacy have opened in one of the area's abandoned buildings in response to the demand for drugs, and some local residents are selling medications from their homes.

"Though this private clinic is expensive, it's much better than our local clinic," said another resident.